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Atrial Fibrillation (Management of Patients with)

Atrial Fibrillation (Management of Patients with). Joint ESC/ACC/AHA Guidelines 2006 Developed in collaboration with the European Heart Rhythm Association (EHRA) and the Heart Rhythm Society (HRS). Atrial Fibrillation.

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Atrial Fibrillation (Management of Patients with)

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  1. Atrial Fibrillation (Management of Patients with) Joint ESC/ACC/AHA Guidelines 2006 Developed in collaboration with the European Heart Rhythm Association (EHRA) and the Heart Rhythm Society (HRS) European Heart Journal (2006):27, 1979-2030

  2. Atrial Fibrillation • Supraventricular tachyarrhythmia characterized by uncoordinated atrial activation with consequent deterioration of mechanical function • Most common sustained cardiac rhythm disturbance • 2.3 mill. N.America, 4.5 mill EU: parox AF/ persist AF • Prevalence increases with age • Often associated with structural heart disease • Acute temp causes: etoh, hyperthyr, surgery, peri-/myocarditis, MI, PE, pulm.dis, metabolic,… • Haemodynamic impairment and thromboembolic events result in significant morbidity, mortality, cost Joint ESC/ACC/AHA Guidelines

  3. Patterns of Atrial Fibrillation Joint ESC/ACC/AHA Guidelines

  4. Management strategies • Rate control • no commitment to restore or maintain SR • beta bl., diltiazem, verapamil; HF: digox; acc.pw: amiodar • Prevention of thromboembolism • antithrombotic therapy recommended to all AF, exc.lone AF or CI • agent based upon risk of stroke/bleeding • Correction of rhythm disturbance (?) • restoration and/or maintenance of sinus rhythm • also requires attention to rate control Joint ESC/ACC/AHA Guidelines

  5. Prevention of thromboembolism Joint ESC/ACC/AHA Guidelines

  6. Cardioversion of AF: recommendations • AF + rapid VR + HD-instability: DC-cardioversion • AF + rapid VR + angina, HT, HF + no prompt response to pharm. Measures: DC-cardioversion • rhythm control (pharmacological and DC-cardioversion !): • < 48h duration, anticoagulation before/after according risk • > 48h/unknown duration: • antico 3w prior to and 4w after • TOE: no thrombus, antico during and 4w after • consider AAD-pretreatment (if safe!) • Interruption of antico for procedures: • antico may be interrupted for up to 1 wk without heparin-subst • mechanical prosthetic valves + prior stroke/TIA: (lmw)heparin subst Joint ESC/ACC/AHA Guidelines

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